Provider Demographics
NPI:1689633323
Name:STEVENSON, SONJA RAECHEL (MD)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:RAECHEL
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 N HIGLEY RD
Mailing Address - Street 2:SUITE B101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-9602
Mailing Address - Country:US
Mailing Address - Phone:480-664-6400
Mailing Address - Fax:480-500-5779
Practice Address - Street 1:861 N HIGLEY RD
Practice Address - Street 2:SUITE B101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-9602
Practice Address - Country:US
Practice Address - Phone:480-664-6400
Practice Address - Fax:480-500-5779
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26938208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ522830Medicaid